Lucena Fernanda A, Costa Ricardo F A, Stein Maira D, Andrade Carlos E M C, Cintra Geórgia F, Vieira Marcelo A, Dufloth Rozany M, Fregnani José Humberto T G, Dos Reis Ricardo
Faculty of Health Science of Barretos Dr. Paulo Prata, Avenida Loja Maçônica Renovadora 68, Nº 100, Barretos, 14785-002 São Paulo Brazil.
2Department of Pathology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331 - Dr. Paulo Prata, Barretos, 14784-400 São Paulo Brazil.
BMC Clin Pathol. 2018 Oct 5;18:11. doi: 10.1186/s12907-018-0078-z. eCollection 2018.
to evaluate the intraobserver and interobserver reproducibility of cervical cytopathology according to previous knowledge of whether patients received radiotherapy (RT) treatment or not.
The study analyzed a sample of 95 cervix cytological slides; 24 with cytological abnormalities (CA) and presence of RT; 21 without CA and presence of RT; 25 without CA and without previous RT; 25 with CA and without previous RT. Two cytopathology (CP) evaluations of the slides were carried out. For the first CP re-evaluation, the cytotechnologist was blinded for the information of previous RT. For the second CP re-evaluation, the cytotechnologist was informed about previous RT. The results were analyzed through inter and intraobserver agreement using the unweighted and weighted kappa.
Post radiotherapy effects were identified in 44.4% of cases that undergone previous pelvic RT. The agreement for RT status was 66.32% (unweighted K = 0.31, 95%CI: 0.13; 0.49, moderate agreement). The intraobserver agreement, regarding the cytological diagnoses, regardless of radiotherapy status, was 80.32% (weighted K = 0.52, 95%CI: 0.34; 0.68). In no RT group, the intraobserver agreement was 70% (weighted K = 0.47, 95%CI: 0.27;0.65) and in patients that received RT, the intraobserver agreement was 84.09% (unweighted K = 0.37, 95%CI: 0.01;0.74). The interobserver agreement between cytopathology result (abnormal or normal) in the group with RT, considering normal and abnormal CP diagnosis was 14.0% and 12.5%, respectively. There was no association between the cytological alterations and the median time between the end of RT and the cytological diagnosis.
This study showed that RT has an important impact in CP diagnosis because the agreement, also in interobserver and intraobserver analysis, had high discrepancy in patients that received RT. Also, demonstrated that it is difficult to recognize the presence of RT in cytological slides when this information is not provided.
根据患者是否接受过放射治疗（RT）的既往信息，评估宫颈细胞病理学检查中观察者内和观察者间的可重复性。
本研究分析了95份宫颈细胞学玻片样本；其中24份存在细胞学异常（CA）且接受过RT治疗；21份无CA但接受过RT治疗；25份无CA且既往未接受过RT治疗；25份有CA且既往未接受过RT治疗。对玻片进行了两次细胞病理学（CP）评估。在第一次CP重新评估时，细胞技术人员对既往RT治疗信息不知情。在第二次CP重新评估时，细胞技术人员被告知既往RT治疗信息。通过使用未加权和加权kappa统计量分析观察者间和观察者内的一致性来分析结果。
在既往接受过盆腔RT治疗的病例中，44.4%发现了放疗后效应。RT治疗状态的一致性为66.32%（未加权K = 0.31，95%CI：0.13；0.49，中度一致性）。无论放疗状态如何，观察者内关于细胞学诊断的一致性为80.32%（加权K = 0.52，95%CI：0.34；0.68）。在未接受RT治疗组中，观察者内一致性为70%（加权K = 0.47，95%CI：0.27；0.65），在接受RT治疗的患者中，观察者内一致性为84.09%（未加权K = 0.37，95%CI：0.01；0.74）。在考虑正常和异常CP诊断的RT治疗组中，细胞病理学结果（异常或正常）的观察者间一致性分别为14.0%和12.5%。细胞学改变与RT治疗结束至细胞学诊断之间的中位时间无关联。
本研究表明，RT对CP诊断有重要影响，因为在接受RT治疗的患者中，无论是观察者间还是观察者内分析，一致性都存在很大差异。此外，研究表明，当未提供此信息时，很难在细胞学玻片中识别出RT治疗的存在。
